---
type: claim
domain: health
description: FDA's TEMPO + CMS ACCESS model enables digital health for Medicare patients targeting hypertension while OBBBA Medicaid cuts remove coverage for the demographic with highest non-control rates
confidence: experimental
source: FDA TEMPO pilot announcement (Dec 2025), CMS ACCESS model documentation
created: 2026-03-31
attribution:
  extractor:
    - handle: "vida"
  sourcer:
    - handle: "u.s.-food-and-drug-administration"
      context: "FDA TEMPO pilot announcement (Dec 2025), CMS ACCESS model documentation"
related: ["the FDA now separates wellness devices from medical devices based on claims not sensor technology enabling health insights without full medical device classification"]
---

# The TEMPO pilot creates Medicare digital health infrastructure while simultaneous Medicaid coverage contraction creates a structural divergence where regulatory innovation serves the elderly while coverage loss affects working-age populations with worse hypertension outcomes

The TEMPO pilot represents the first combined FDA enforcement-discretion + CMS reimbursement pathway for digital health devices, explicitly targeting hypertension in the 'early cardio-kidney-metabolic' category. Up to 10 manufacturers per clinical area can deploy uncleared devices to Medicare patients in the ACCESS model while collecting real-world evidence. This creates genuine market entry infrastructure that didn't exist before January 2026.

However, TEMPO operates exclusively within Medicare (65+ population) through the ACCESS model. The source notes explicitly state that 'The population with the worst hypertension control rates (low-income, food-insecure, working-age) is primarily in Medicaid, not Medicare.' Meanwhile, OBBBA is systematically removing Medicaid coverage for exactly this working-age population.

This creates a structural contradiction: FDA is building digital health infrastructure for the Medicare population (which has better baseline access and outcomes) while coverage infrastructure deteriorates for Medicaid populations with demonstrably worse hypertension control. The KB already documents that only 23% of treated US hypertensives achieve blood pressure control, and that hypertension-related CVD mortality doubled 2000-2023. TEMPO's scale (10 manufacturers, research setting) cannot address population-level control failures, and its Medicare focus systematically excludes the populations most in need.

The equity dimension is revealing: CMS ACCESS includes rural patient adjustments but no income-stratified or urban food desert measures. The ACP (Affordability Connectivity Program) subsidy for internet access was discontinued June 2024, removing the connectivity infrastructure TEMPO-eligible patients in low-income urban settings would need. This suggests TEMPO is optimizing for a Medicare research population with existing connectivity rather than expanding access to underserved populations.

---

### Additional Evidence (extend)
*Source: [[2026-04-01-fda-tempo-cms-access-selection-pending-july-performance-period]] | Added: 2026-04-01*

TEMPO manufacturer selection remains pending as of April 1, 2026, two months after statements of interest closed. CMS ACCESS model applications were due April 1, 2026 with first performance period July 1, 2026. This creates a chicken-and-egg problem: healthcare systems applying to ACCESS must do so without knowing which TEMPO-approved devices they can deploy. The July 1 start date creates operational urgency for TEMPO selection in April/May 2026.


Relevant Notes:
- only-23-percent-of-treated-us-hypertensives-achieve-blood-pressure-control-demonstrating-pharmacological-availability-is-not-the-binding-constraint.md
- hypertension-related-cvd-mortality-doubled-2000-2023-despite-available-treatment-indicating-behavioral-sdoh-failure.md
- the FDA now separates wellness devices from medical devices based on claims not sensor technology enabling health insights without full medical device classification.md
- rpm-technology-stack-enables-facility-to-home-care-migration-through-ai-middleware-that-converts-continuous-data-into-clinical-utility.md

Topics:
- [[_map]]
